Research suggests Nepal can expand medication abortion in pharmacies without compromising pregnancy prevention

Efforts to improve access to medication abortion have led to rapid expansion of services in Nepal. While expanding the types of clinicians and settings where medication abortion is available makes services more accessible, it could have unintended consequences. New Bixby research explores whether providing medication abortion by auxiliary nurse-midwives in pharmacies has any impact of adoption of post-abortion birth control.

Researchers found that 79% of patients had started a birth control method by the time they came in for a post-medication abortion follow-up visit. There was no significant difference in the percentage of women who adopted an effective birth control method between women who obtained a medication abortion at a public health facility and those who got their medication abortion at a pharmacy. That was true also for long-acting contraceptive methods.

Of the women who were not using any contraceptive method after their medication abortion, the most common reason was that their husbands were away, followed by infrequent sex, fear of adverse effects and partner opposition. 

Previous research has shown challenges to providing post-abortion contraception, including inadequate time for counseling, privacy and space limitations, shortages of trained staff and supplies and stigmatization of women having abortions. Those challenges could be elevated outside of clinical settings. The fact that this did not play out in this study could be due to the fact that all the providers were trained auxiliary nurse-midwives who had worked in both pharmacies and clinical settings.

The results suggest that Nepal can expand medication abortion access in pharmacies, and mitigate the dangers of unsafe abortion, without compromising pregnancy prevention.